Abstract
Background: The demonstration of pulmonary vein (PV) occlusion is routinely performed and considered a prerequisite for successful cryoballoon (CB) ablation of atrial fibrillation (AF). The purpose of this study was to assess the feasibility and impact on procedural parameters and outcome of a standardized procedural protocol without demonstrating PV occlusion.Methods and Results: Consecutive patients undergoing CB pulmonary vein isolation (PVI) were studied. After cMRI assessment, patients treated by PVI using a novel no-contrast (NC) protocol without routine contrast injections to demonstrate PV occlusion (NC group) were compared to patients undergoing PVI with contrast injections to demonstrate PV occlusion (standard group). One hundred patients with paroxysmal or persistent AF (age 61 ± 10 years, ejection fraction 59 ± 11%, left atrial volume index 37.2 ± 2.0 mL/m2) were studied. The NC protocol was feasible in 72 of 75 patients (96%). Total procedure time and fluoroscopy time were 64.0 ± 14.1 min and 11.0 ± 4.6 min in the NC group and 92.0 ± 25.3 min and 18.0 ± 6.0 min in the standard group, respectively (all p < 0.001). Dose area product was 368 ± 362 cGy*cm2 in the NC group compared to 1928 ± 1541 cGy*cm2 in the standard group (p < 0.001). Forty-five of 75 patients (60%) in the NC group and 16 of 25 patients (64%) in the standard group remained in stable sinus rhythm after a single PVI and a 1-year follow-up (p = 0.815).Conclusions: Performing CB ablation without using contrast injections to demonstrate PV occlusion was feasible, resulted in reduced radiation exposure, and increased the efficiency of the procedure.
Highlights
Pulmonary vein (PV) isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF) and may be achieved by means of radiofrequency (RF) ablation or cryoballoon (CB) ablation [1,2,3]
Improvements in procedural workflows and learning curves have resulted in decreased procedure and fluoroscopy times [9,10,11], radiation doses and contrast use with CB ablation remain considerably higher compared to RF-pulmonary vein isolation (PVI) guided by a mapping system
This is mainly due to the use of fluoroscopy during contrast injections for the confirmation of PV occlusion which are routinely performed during CB ablation of AF
Summary
Pulmonary vein (PV) isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF) and may be achieved by means of radiofrequency (RF) ablation or cryoballoon (CB) ablation [1,2,3]. Improvements in procedural workflows and learning curves have resulted in decreased procedure and fluoroscopy times [9,10,11], radiation doses and contrast use with CB ablation remain considerably higher compared to RF-PVI guided by a mapping system. This is mainly due to the use of fluoroscopy during contrast injections for the confirmation of PV occlusion which are routinely performed during CB ablation of AF. The demonstration of pulmonary vein (PV) occlusion is routinely performed and considered a prerequisite for successful cryoballoon (CB) ablation of atrial fibrillation (AF). The purpose of this study was to assess the feasibility and impact on procedural parameters and outcome of a standardized procedural protocol without demonstrating PV occlusion
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
